Seems like you are a seasoned attending and I value your advice ( as well as the other members in this forum). What do you think about starting your career as a junior attending in academic hospital vs private or community practice. So far, I have 6 offer letters in front of me in various settings and I am having very hard time to pick one. I always thought academia as an ideal setting to step in attending realm due to career advancement, learning opportunities and supervision from more experienced faculty. I do feel like in community mental health setting, advancement opportunities would be limited ( I guess the top position would be advancement to medical directorship after 20 years of service?). With private practice, the only advancement I see is buying in the practice or opening your brand new one but unless you create a brand practice like Talkiatry, Amen clinics or Lifestance (which are mostly managed by corporations or like minded people unfortunately) my horizon does not extend further after being an owner or a partner.
The only continuous career-wise lifelong advancement I see is in academia. I would like experienced and seasoned psychiatrist to give their insight in this thread. Money and benefits are must but I do feel like at some point ( probably less than 5 years) , they wont mean much , boredom will sink in and lead to eventual burn out. Maybe that`s why Medscape survey revealed that physicians in academia are less likely to be burned out?
I think many physicians struggle to get out of this mentality. We're so used to jumping through hoops to the next stage (getting into med school, getting through med school, getting into residency, then fellowship, then job etc), it can be hard to imagine a world where there isn't a next step or where you're not receiving some affirmation or your self-worth as determined by some metric. But once you've finished your training, you've made it! you can take a deep breath, and relax! You don't have to keep churning or jumping through hoops if you don't want to. Being a psychiatrist is
good enough.
Now, of course there is nothing wrong with advancing through your career but it is important to take a step back and ask yourself why? Many physicians have no idea why they feel compelled to keep striving for more. Sometimes it is because that is what you've been programmed to do. Sometimes it is because you are hoping your career will provide you with something that you should be getting elsewhere. Sometimes, it is because you are escaping from your lack of self-worth. None of these are good reasons. Better reasons would be having a specific vision of what sounds like a fulling pathway, having a desire to provide more that patient care (e.g. working with systems, program development, education, policy etc)
While there are numerous opportunities for professional development in academia, most faculty are academic failures who never meaningfully progress, and many leave. There are in fact numerous opportunities for professional development and advancement outside of academia. Medical director positions tend to be entry level positions in many organizations, and sometimes the title is a euphemism for someone who supervises multiple NPs. You can progress in administrative roles including things like regional medical director, department chair/chief, chief medical officer, chief executive officer, chief wellness officer, chief informatics officer, chief innovation officer, vice president, president etc. One can also advance in governmental positions (for example through the VA, the county, the state hospitals or prisons, in corrections, the bureau of prisons, for SAMHSA or HHS), work for the commerical insurance industry, work for medicaid, work for medicare administrators (e.g. noridian) work for pharma or tech etc. It is possible to have a diverse portfolio of clinical and non-clinical work that helps to keep things interesting.
That said, while people love to hate on academia in this forum (including/especially those who actually are in academics lol), there can be a lot of benefits with the right job for the right person. unfortunately, there are many pseudoacademic positions (e.g. affiliated hospitals), or production driven jobs (i.e. working clinically hard for meagre pay) at academic medical centers nowadays. If you are taking an academic position it should afford you the benefits of such (e.g. time for research, significant responsibilities and interface with med students, residents and fellows, protected time for teaching, opportunities for educational or clinical leadership positions, mentorship, reduced patient load). Unfortunately, the golden age of academic medicine is long gone and we are in this stage of change where administrators want clinician-educator faculty to produce more than the median wRVUs for 10-25 %ile salary, along with requirements in teaching, supervision, publishing, presenting and committee service without additional or any compensation.
